孕前超重肥胖女性孕早期糖脂代谢与妊娠期糖尿病的发病关系

The Relationship between Glucose and Lipid Metabolism and GDM in Early Pregnancy in Overweight and Obese Women

目的:探讨孕前超重肥胖女性孕早期糖脂代谢与妊娠期糖尿病(GDM)的发病关系。方法:选取2019年1月—2020年5月在中山市博爱医院早孕建册且首次产检的孕前超重肥胖孕妇60例,于孕早期(孕12周)测定患者糖脂代谢指标[低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、糖化血红蛋白(HbA1c)、空腹血糖(FBG)],均行孕期指导,并于孕24周后行75 g糖耐量试验(OTGG),统计孕妇GDM发生情况。分析孕前超重肥胖女性孕早期糖脂代谢与GDM发生的关系。结果:60例孕前超重肥胖孕妇中发生GDM的有15例,占比25.00%;发生GDM孕妇年龄、孕前BMI与未发生GDM孕妇比较,差异无统计学意义(P>0.05);发生GDM孕妇的FBG、HbA1c、LDL-C、TG水平均高于未发生GDM的孕妇,差异有统计学意义(P<0.05)。绘制ROC曲线,结果显TG、LDL-C、HbA1c、FBG及联合检测评估孕妇GDM发生情况的AUC为0.602、0.665、0.743、0.751、0.859,其中联合检测的评估价值最好。结论:孕前超重肥胖女性中发生GDM者的FBG、HbA1c、LDL-C、TG水平均明显升高,出现糖脂代谢紊乱,故检测TG、LDL-C、HbA1c、FBG等糖脂代谢指标能有效评估GDM发生情况。

Objective:To investigate the relationship between glucose and lipid metabolism in early pregnancy and gestational diabetes(GDM)in overweight and obese women before pregnancy.Methods:A total of 60 pre-pregnancy overweight and obese pregnant women who were registered at the hospital from January 2019 to May 2020 and had their first birth checkup were selected.The glucose and lipid metabolism indexes of the patients were measured in the first trimester(12 weeks of gestation)(low density lipoprotein cholesterol[LDL-C],triacylglycerol[TG],glycosylated hemoglobin[HbA1 c],fasting blood glucose[FBG])were all guided during pregnancy,and 75 g glucose tolerance test(OTGG)was performed after 24 weeks of gestation to calculate the incidence of GDM in pregnant women.The relationship between glucose and lipid metabolism in early pregnancy and the occurrence of GDM in overweight and obese women before pregnancy were analyzed.Results:15 of the 60 pre-pregnancy overweight and obese pregnant women developed GDM,accounting for 25.00%.There was no statistically significant difference in the age and BMI of pregnant women with GDM and those without GDM(P>0.05).The levels of FBG,HbA1 c,LDL-C and TG of pregnant women with GDM were higher than those of pregnant women without GDM,and the difference was statistically significant(P<0.05).The ROC curve was drawn,and the results showed that the AUC of TG,LDL-C,HbA1 c,FBG and combined testing to assess the occurrence of GDM in pregnant women were 0.602,0.665,0.743,0.751,0.859,and the combined testing had the best evaluation value.Conclusion:The levels of FBG,HbA1 c,LDL-C,TG in pre-pregnancy overweight and obese women with GDM are significantly increased,and glucose and lipid metabolism disorders appear.Therefore,detection of TG,LDL-C,HbA1 c,FBG and other glucose and lipid metabolism indicators can effectively evaluate the occurrence of GDM.